| NPI | 1306453691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13840) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX PA13840) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2023-02-23 |